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Observational Study
. 2024 Feb 8;19(2):e0295209.
doi: 10.1371/journal.pone.0295209. eCollection 2024.

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

Shivali Srivastava  1 , Ipshita Kak  1 , Pierre Major  2 , Michael Bonert  1
Affiliations
Observational Study

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

Shivali Srivastava et al. PLoS One. .

Erratum in

Abstract

Background: Lymph node status and lymph node count (LNC) are predictors of colorectal cancer outcome. Under-sampling of lymph nodes may lead to clinically relevant stage migration.

Methods: Colorectal cancer (CRC) cases with a synoptic report, accessioned 2012-2020 at a regional laboratory, were extracted and retrospectively studied. LNC, positive lymph node count (PLNC), tumour deposits present (TDpos), and 'y' (staging) prefix (YS) were retrieved and tabulated by pathologist using custom software. Statistical analyses were done with R.

Data and results: The cohort had 2,543 CRC resections. Seventeen pathologists interpreted >50 cases (range: 56-356) each and collectively saw 2,074. After cases with unavailable data were purged, 2,028 cases remained with 43,996 lymph nodes, of which 2,637/43,996 were positive. 368 cases had a 'y' prefix, and 379 had TDpos. The 17 pathologists' median LNC/case was 19.0 (range: 14.0-24.0), and the mean PLNC per case was 1.4 (range: 1.0-2.0). Kruskal-Wallis rank sum tests showed there were differences in LNC (p<0.001) among pathologists; however, PLNC did not show this association (p = 0.2917). T-tests showed that mean LNC (p<0.001) and PLNC (p<0.035) differed between YS. 138 of 2,028 cases had less than the 12 LNC target. Logistic regression revealed a strong association between meeting the LNC target and pathologist (p<0.001) but TDpos was non-predictive (p = 0.4736).

Conclusions: Positive lymph node call rate has a good consistency in the laboratory; however, lymph node count varies significantly between pathologists. Standardized counting criteria are needed to improve uniformity and could be aided by synoptic reporting data.

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Conflict of interest statement

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. The corresponding author (MB) retains the copyright on the computer code that was written outside of his employment relationship with McMaster University/St. Joseph’s Healthcare Hamilton/Hamilton Regional Laboratory Medicine Program. The above does not in any way limit adherence to the PLOS ONE data availability policy, as found here: https://journals.plos.org/plosone/s/data-availability. There is no financial conflict of interest. There are no conflicts for the other authors.

Figures

Fig 1
Fig 1. Box-whisker plot of lymph node count by pathologist (for pathologists interpreting greater than 50 cases).
Any two boxes with non-overlapped notches have approximately a 95% confidence interval or greater for the difference between the medians; this would roughly correspond to p<0.05.
Fig 2
Fig 2. Lymph node count by ‘y’ TNM staging modifier status.
The non-overlap of the notches is in keeping with a significant statistical difference (p<0.05) between the two groups, as also found with a T-test.
See this image and copyright information in PMC

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